Tuesday, October 31, 2017

As we've written about before on Cancer News in Context, good evidence points to the important role that behaviors in youth and young adulthood can have on cancer risk later in life.

Health habits started in youth not only have a longer time to impact risk, but they can also have unique and important interactions with the biology of certain developmental stages. Smoking, for example, seems to have the biggest impact on breast cancer risk when it takes place in the years between a woman's first period and when she first gives birth. Likewise, sun exposure and indoor tanning has its biggest impact on melanoma risk when it takes place early in life.

Though there is still a lot we don't know about the relationship between early life risk factors and disease risk later in adulthood - largely because the vast majority of studies to date have been done in middle-aged or older populations - it is clear from the studies we do have that the earlier in life we can cement healthy habits, the better.

Yet, a new study of national data shows that there's still great room for improvement in those critical early years. The study, conducted by researchers from the National Center for Chronic Disease Prevention and Health Promotion of the CDC, analyzed results from the 2015 National Health Interview Survey, which asked a random sampling of Americans about a range of health habits and related information.

Across nearly all behaviors reported, there were very few bright spots (see figure below).

Nearly 20 percent of all young adult men and women were obese, meaning they had a body mass index (BMI) of 30 or higher. For someone who is 5 feet, 5 inches tall, that translates to a weight of 180 pounds or more. And these numbers do not even include the percentage of young adults who were overweight (BMI 25 - 29.9) but not obese. While obesity has the largest weight-related impact on the risk of cancer, simply being overweight also adds to risk.

While smoking rates have dropped dramatically from their high-points, 11 percent of young women and 15 percent of young men still smoke tobacco cigarettes. And nearly 8 percent of young men use e-cigarettes, despite their short and long-term risks remaining largely unknown.

Though physical activity is one of the best ways to lower disease risk and improve health and overall quality of life, nearly 30 percent of young women and just over 20 percent of young men get little or no physical activity.

Indoor tanning - which can double the risk of deadly melanoma - remains relatively popular in young women. While, overall, 11 percent of women ages 18 - 24 had used a tanning bed in the past year, this number kicks up to 17 percent in non-Hispanic whites. Two percent or less of young men had indoor tanned.

Perhaps the most striking numbers were the very high rates of sugary drink consumption, processed meat consumption, and lack of HPV vaccination. Over half of men and women drank sugary drinks daily, which increases the risk of weight gain, among other health risk factors. And over two-thirds of men and over half of women regularly ate processed meat, which increases the risk of colon cancer.

Approximately 58 percent of women 18 - 26 years old and 79 percent of men 18 - 21 years old had not had the HPV vaccine, despite it lowering the risk of multiple cancers - including those of the cervix, anus, penis, and throat (which is becoming increasingly common). (Data not included in figure).

We know that half of all cancers could be prevented with a healthy lifestyle, and that that number is likely higher when healthy behaviors start early in life and are maintained through adulthood. The results of this new study show that much more work needs to be done to help instill healthy behaviors in childhood that then continue into the teens and early twenties and beyond.

Parents and other family members play a key role in helping children develop healthy habits. As kids age, and their independence grows, they play an increasing role in their own health. At all stages, though, neither parents nor kids nor adults exist in a vacuum. Our health behaviors are influenced by numerous different factors. Personal choice is just one. And outside of that, our schools, neighborhoods, workplaces, friends and broader social circles, and local and state governments and policies have an important impact on the health behaviors we make and sustain.

Healthy school meals and daily PE can help lay the foundation for a lifetime of healthful eating and regular activity. Nice sidewalks and bike paths can make it easier for families to get out for walks and bike rides. Employers that provide affordable health insurance and allow time off for doctor's appointment make it easier for workers to get important preventive care and screening. Promotion of healthy choices by popular opinion leaders on Snapchat and Instagram can impact attitudes and choices of teenagers influenced by such social media. And targeted taxes on tobacco and sugary drinks can curb purchasing by youth and young adults, who are particularly sensitive to cost.

To make important headway against cancer and other preventable chronic diseases, we need to promote and support prevention on these multiple levels. The lessons from tobacco show that such broad-based approaches work. What is lacking in these other areas are appropriate resources and political will to tackle them as we've been able to do tobacco.

The return on the time and resources invested would, no doubt, be many times over.

Thursday, October 26, 2017

Two years ago during Breast Cancer Awareness Month, we posted over nine days excerpts from our, then, new book TOGETHER: Every Woman's Guide to Preventing Breast Cancer. Each of the nine days focussed on a single practical step that could help lower the risk of the disease. With each of the steps still relevant and important - and, we hope, still practical - we thought we'd post the compact list - nine days in one - and let readers click through a la carte.

Although e-cigs are often marketed as safer alternatives to standard cigarettes – with some analyses showing they could have some benefits in narrow scenarios – good evidence remains lacking on their risks, on their effectiveness as a smoking cessation aid, and on their impact on youth and adult smoking rates.

The lack of such important information warrants restrictions on their sale and use.

Standard cigarettes remain the top preventable cause of death in the United States, and the primary goal of any tobacco smoker should be to quit. E-cigs, however, are not an FDA-approved method for helping smokers quit. Approved cessation aids include nicotine gum, lozenges and patches, and certain medications. Seeing a doctor for help quitting can double a smoker’s chance of success.

Thursday, July 13, 2017

Ever wonder how you're state stacks up compared to others when it comes to important health risk factors? If so, a tool from the Centers for Disease Control and Prevention (below) can help you do just that. And while it can be fun to click through and explore the data from different states and for different risk factors, the tool helps illustrate an important point: that health, and the health choices we all make, are part of the broader world in which we live. The policies, infrastructure, and social environment that surround us can have an important influence on things like how active we are, what food we eat, and the preventive healthcare we get. For healthy individuals, and a healthy nation, these aspects need to work together: the healthy choices people make, and the settings that foster and support those choices.

A past associate director of the Center, Colditz also paid tribute to groundbreaking nutrition researcher, George Blackburn, who passed away in February 2017 and played a key leadership role in establishing BNORC and fostering its important work. In addition to discussing Blackburn's role in advancing such fields as obesity economics, chronic disease prevention, and bariatric surgery, Colditz also recounted how Blackburn's driven nature also translated to his driving habits on Boston's infamous roads, with oftentimes exciting results.

"George offered to drive me back to my office on Longwood Avenue," said Colditz. "I accepted, and am pleased to say I survived a dash through city traffic with George at the wheel, a harrowing experience I expect many other here have shared over the years."

Despite the stress his driving may have caused in others, Blackburn, and BNORC in general, did a great deal to help shape our current understanding of health and prevention. Key studies showed the important role of adult weight gain on the risk of heart disease and breast cancer - and that BMIs within the upper end of the "normal" weight range could still significantly increase the risk of diabetes and heart disease.

Findings like these played an important role in shaping national health policy, possibly most notably with the practical recommendation in the 1995 Dietary Guidelines for Americans that adults should "maintain or improve weight," rather than simply focus on trying to achieve a healthy weight, which is not practical for many people. Simply avoiding future gain could have large benefits across many types of diseases and across the nation.

Other advances the work of BNORC played a role in was in identifying links between overweight and cancer, with much of this work foundational to a 2016 International Agency for Research on Cancer (IARC) report detailing the strong association between excess weight and 13 different cancers, including: breast, colon and rectum, endometrial, esophageal (adenocarcinoma), gallbladder, gastric, kidney (renal cell), liver, multiple myeloma, ovary, pancreas, and thyroid.

As our understanding of the weight-cancer link grows, said Colditz, we may in the future be better able to personalize lifestyle recommendations for people - to help them lower their future risk of cancer or improve their prognosis as cancer survivors. As well, we may better be able to understand how to allocate resources across the population for maximum impact.

Tuesday, May 9, 2017

Differences in life expectancy in the United States can vary greatly depending on the county in which you live. That's the finding of a new analysis out of the University of Washington and published in the journal JAMA Internal Medicine.

Using data from the Human Mortality Database, National Center for Health Statistics, and U.S. Census Bureau, researches calculated the average life expectancies of counties between the years 1980 and 2014. They also assessed factors in the counties that could impact health - and therefore life expectancy - such as health behaviors, socioeconomic status (SES), and access to health care.

The analysis revealed a very large 20-year difference in life expectancy between the counties with the longest life expectancy and those with the shortest. While average life-expectancy for women and men combined was 79 years in 2014, counties with the highest life-expectancy averaged 87 years. Those with the lowest averaged just 66 years. Comparing the top 1 percent of counties with the lowest 1 percent, the life-expectancy gap was 11 years. Comparing the top 10 percent of counties with the lowest 10 percent, the gap was 6 years.

Counties on the lower half of the Mississippi River and those on some Native American reservations in South and North Dakota had some of the lowest life expectancy in the nation, while those in central Colorado Counties had some of the highest. A related online dynamic tool allows users to explore life expectancy and mortality rates for counties across the nation.

Looking at trends since 1980, the researchers conclude that inequality in life expectancy in United States is "large and increasing." Though such inequality has dropped in younger groups, it remains stark in older groups and populations as a whole.

In trying to tease out the causes of these disparities, the researchers found that certain health and behavioral factors had the biggest influence. Obesity, lack of physical inactivity, smoking, high blood pressure, and diabetes were found to account for 74 percent of the life expectancy differences between counties.

This new analysis further confirms the importance of addressing growing inequality in the United States. Populations with lower incomes, less education, and more discrimination are more likely to suffer from lifestyles and diseases that result in premature mortality. Programs and policies need to be put in place to narrow these gaps and address these issues.

How long you live and how healthy you are should not depend on where you live. Right now, it can. And we need to change that.

Wednesday, May 3, 2017

A new analysis published last week in the British Journal of Sports Medicine found that physical inactivity results in a significant economic burden the world over. Though the authors found that studies looking at the economic impact of inactivity lacked consistent methodology - which, therefore, limited specific conclusions - sedentary lifestyles were found to account for large percentages of direct health care expenditures in a number of countries. In the United States, 2.4 - 11.1 percent of direct health care expenditures on things like doctors visits and hospital stays were linked to inactivity. In New Zealand, it was 4.5 percent. In China, it was 2.4 percent. And in the United Kingdom, it was 0.3 - 1.5 percent. Globally, the "pandemic" of physical inactivity - as the authors describe it - was estimated in one study to be 0.64 percent.

Ding D, et al. Br. J Sports Med. 2017

And these are just direct health costs from diseases and conditions caused by physical inactivity. Indirect costs, which take into account other economic burdens of physical inactivity, such as lost work productivity and wages, are also substantial.

As the authors conclude:

Based on the findings from the studies reviewed, it is evident that physical inactivity is a costly pandemic that is associated with a substantial disease burden in almost every country where estimates exist.